Type 1 Diabetes Prevention and Delay: What’s Possible, What Isn’t, and What’s Emerging

Can type 1 diabetes be prevented?

Type 1 diabetes cannot currently be prevented. It is an autoimmune condition, where the immune system mistakenly attacks the insulin-producing beta cells in the pancreas.

Unlike type 2 diabetes, type 1 diabetes is not caused by diet, weight, sugar intake, or lifestyle choices. Nothing a parent or individual did — or failed to do — causes type 1 diabetes, and changing lifestyle factors does not prevent it.

That said, research over the past decade has changed how we think about risk. In some high-risk individuals, it is now possible to:

• identify risk years before symptoms appear
• delay the onset of clinical type 1 diabetes
• reduce the severity of presentation at diagnosis

This distinction matters. Prevention is not yet possible — but earlier detection and delayed progression are now real and meaningful goals.

Who is at risk of developing type 1 diabetes?

Type 1 diabetes can affect anyone, at any age. While it is often diagnosed in childhood, around half of new diagnoses occur in adults.

Risk is higher in certain groups, particularly where there is a family history of type 1 diabetes or other autoimmune conditions.

Group	Approximate lifetime risk
General population	~0.4%
Child of a parent with type 1 diabetes	~3–5%
Sibling of someone with type 1 diabetes	~5–8%
Identical twin	~30–50%

Risk is influenced by genetics and the presence of islet autoantibodies, which may appear many years before symptoms. You can explore this in more detail in our guide to risk factors for type 1 diabetes .

Importantly, most people diagnosed with type 1 diabetes have no family history at all. This is why universal prevention is not currently possible.

Can the onset of type 1 diabetes be delayed?

Type 1 diabetes develops in stages. Long before symptoms appear, the immune system may already be damaging insulin-producing cells.

This has led to a shift in research — from trying to prevent type 1 diabetes entirely, to slowing immune attack and delaying clinical disease in people at very high risk.

Teplizumab and immune modulation

A medication called teplizumab is the first therapy approved to delay the onset of type 1 diabetes in people at very high risk — specifically those with multiple diabetes-related autoantibodies and early glucose abnormalities.

In a landmark study published in the New England Journal of Medicine , teplizumab delayed the diagnosis of type 1 diabetes by a median of approximately two years compared with placebo in high-risk relatives of people with type 1 diabetes.

Based on this evidence, teplizumab became the first therapy approved by the U.S. Food and Drug Administration to delay the clinical onset of type 1 diabetes. Importantly, it does not prevent type 1 diabetes altogether and is not suitable for the general population.

Large international research programs such as TrialNet continue to explore safer and more effective strategies for early detection and immune intervention.

Other approaches under investigation

Researchers have also explored:

• Intranasal insulin, aimed at teaching immune tolerance (results so far have been mixed)
• BCG vaccination, with limited and inconsistent benefit to date
• Dietary or vitamin-based interventions, which have not shown reliable preventive effects

At present, no approach reliably prevents type 1 diabetes in the general population.

Once diagnosed: can progression be slowed?

While type 1 diabetes cannot be reversed, diagnosis is not the end of the story. Early management can meaningfully influence long-term outcomes.

Some therapies studied after diagnosis aim to preserve remaining beta-cell function, including:

Calcium channel blockers (verapamil): preserving beta cell function after diagnosis

Another area of active research focuses on whether medications already used for other conditions can help slow the loss of insulin-producing beta cells after a diagnosis of type 1 diabetes. One such medication is verapamil, a calcium channel blocker traditionally used to treat high blood pressure and heart rhythm disorders.

Research suggests that beta cell destruction in type 1 diabetes is driven not only by immune attack, but also by internal cellular stress pathways. One protein involved in this process is thioredoxin-interacting protein (TXNIP), which promotes beta cell dysfunction and death. Laboratory studies have shown that verapamil can reduce TXNIP expression, providing a plausible biological mechanism for preserving remaining beta cell function.

Small clinical trials in people with newly diagnosed type 1 diabetes have explored this effect. In a randomised controlled study published in Nature Medicine, participants who received verapamil alongside standard insulin therapy showed better preservation of C-peptide levels (a marker of the body’s own insulin production) over time compared with placebo. Some participants also required slightly lower insulin doses.

You can read the original study here: Verapamil and beta cell survival in type 1 diabetes (Nature Medicine) .

Importantly, the effects observed were modest. Verapamil did not prevent type 1 diabetes, did not stop the autoimmune process, and did not eliminate the need for insulin. At present, verapamil is not part of routine clinical care for people with type 1 diabetes and should only be considered within specialist settings or research protocols.

This research is best viewed as part of a broader effort to understand how beta cell loss might be slowed after diagnosis, rather than as a prevention strategy. Ongoing studies continue to explore whether combining immune-targeted therapies with beta-cell-protective approaches could lead to better long-term outcomes.

Equally important is early education. Understanding insulin, monitoring, food, activity, and technology from the start leads to better confidence, safer control, and lower long-term risk.

For people newly diagnosed — or supporting a child or family member — our Type 1 Diabetes Program provides structured, medically guided education to help people navigate the condition with clarity rather than fear.

What should I do now?

If you or someone you care for may be at risk of type 1 diabetes, the most important steps are awareness and timely action.

• Know the early symptoms of type 1 diabetes
• Understand individual risk factors
• Seek prompt medical assessment if symptoms appear

Early diagnosis reduces the risk of severe presentation and helps prevent early complications. Importantly, diagnosis should not rely on a single test alone — including HbA1c — as explained in our guide to HbA1c testing .

Once diagnosed, education and support matter as much as insulin. Most people do best when they understand why decisions are made, not just what they are told to do.